Improving Stroke Outcomes With Technology

Stroke is the fifth-leading cause of death in the United States, killing nearly 129,000 people each year. Stroke is also the country’s leading cause of adult disability.

The good news is that these numbers are decreasing. Only a few years ago, theAmerican Stroke Association reportedthat stroke was the third cause of death in women and the fourth cause of death in men. And over the past decade, the death rate has decreased 34 percent and the number of stroke deaths has dropped about 18 percent, changes the organization attributes to public education efforts and the development of new technologies and techniques to treat stroke.

One treatment that has had a significant effect on stroke-related death and disability is a procedure called mechanicalthrombectomy, which uses a stent-on-wire, also known as a “stroke stent” or “stentriever.” While still relatively new,CarilionClinic has been conducting this procedure since it gained FDA approval in 2012.

According toBirajM. Patel, M.D.,CarilionClinic’sneurointerventionalsurgery/radiology section chief, the trend in stroke treatment is towardendovascularmechanicalthrombectomy, both nationally and in our region.

“There has been a swing in the pendulum towardendovasculartherapy since the data released at the International Stroke Conference in February 2015 showed efficacy ofendovasculartreatment +/- IV tPA (clot-buster) versus clot-buster alone in a selected group of patients,” said Dr. Patel.

The procedure, detailed by Dr. Patel in the video below, allowsinterventionaliststo manually extract a clot quickly using catheters and a stroke stent.

“We put a cage-like device that is on a wire that’s deployed across the clot to incorporate it," he explained. "Next, a bigger catheter is brought to the clot and that catheter is used to essentially extract the clot with the device as a unit. With new technology and devices and improved techniques over the years we are able to recanalize—or unblock and restore blood flow—for more and more patients."

Dr. Patel reports that for every 100 patients treated, about 40 will have a better functional outcome at three months, including 25 more who achieve functional independence when followed up long-term.

“In other words, for every 2.5 patients treated, one more patient has a better disability outcome," he said. "And for every four patients treated, one more patient is independent at long-term follow up.”

Recognizing a Stroke
CarilionClinic neurologistSidneyMallenbaum, M.D., reports that stroke patients lose 2 million brain cells for every minute they go untreated. “When you have a stroke, the clock starts,” he said.